心肺超声在脓毒血症合并急性肾损伤中的运用

心肺超声在脓毒血症合并急性肾损伤中的运用

作者：盛莉余苏姣吕华瑶

来源：《中国现代医生》2022年第14期

[摘要] 目的探讨心肺超声在重症监护病房（ICU）脓毒症合并急性肾损伤中的运用。方法回顾性分析2017年12月至2021年6月入住杭州市第一人民医院ICU脓毒症合并急性肾损伤患者临床资料和心肺超声特征。根据临床结局，分为28 d病死组和28 d存活组，每组各32例，比较两组心肺超声参数：下腔静脉内径（IVC）、下腔静脉吸气塌陷率（IVC-CI）、左室内径（LVIDD）、每分钟输出量（CO）、肺动脉收缩压（PASP）、左室射血分数（EF）、二尖瓣E波速度和二尖瓣环舒张早期速度比值（E/e’）、双肺超声评分。应用logistic回归分析28 d病死影响的因素。运用受试者工作特征曲线（ROC）评价心肺超声参数预测28d病死的效能。结果与28 d存活组比较，28 d病死组IVC、PASP、E/e’、双肺超声评分、肌红蛋白（MYO）明显升高，下腔静脉吸气塌陷率、CO、EF、平均动脉压（MAP）显著减低，差异均有统计学意义（P

[关键词] 脓毒症;急性肾损伤;超声心动描述术;重症监护病房

[中图分类号] R459.5 [文献标识码] B [文章编号] 1673-9701（2022）14-0115-05

Application of cardiopulmonary ultrasound in sepsis complicated with acute kidney injury

SHENG Li YU Sujiao LYU Huayao

1.Department Imaging Chengbei Branch，Hangzhou First People′s Hospital， Hangzhou 310022， China;

2.Department of Critical Medicine，Hangzhou First People′s Hospital， Hangzhou 310022，China

[Abstract] Objective To explore the application of cardiopulmonary ultrasound in the patients with sepsis complicated with acute kidney injury in the intensive care unit（ICU）. Methods The clinical data and cardiopulmonary ultrasound characteristics of patients with sepsis complicated with acute kidney injury who were admitted to Hangzhou First People′s Hospital from December 2017 to June 2020 were restrospectively analyzed. According to the clinical outcome， they were divided into a 28-day death group and a 28-day survival group. There were 32 patients in each group. Cardiopulmonary ultrasound parameters， such as the inferior vena cava inner diameter （IVC），inferior vena cava inspiratory collapse rate， left ventricular diameter （LVIDD），output per minute （CO）， left ventricular ejection fraction （EF）， pulmonary artery systolic pressure （PASP），ratio of mitral valve E wave velocity and mitral ring early diastolic velocity （E/e′），and bilaterial lung ultrasound score were compared between the two groups. Logistic regression was used to analyze the influencing factors of 28-day death.The receiver operating characteristic curve （ROC） was used to evaluate the effectiveness of cardiopulmonary ultrasound parameters in predicting 28-day death. Results Compared with the 28-day survival group，the IVC，PASP，E/e′，bilateral lung ultrasound score， and myoglobin （MYO） in the 28-day death group were significantly increased， while the inspiratory collapse rate of the inferior vena cava， CO， EF，and mean arterial pressure （MAP） were significantly reduced. The differences were statistically significant（P0.05）.Multivariate logistic regression analysis showed that IVC，EF，PASP，and bilaterial lung ultrasound scores were independent risk factors for 28-day death caused by sepsis complicated with acute kidney injury. The predicted area under the ROC curve （AUC） of 28-day death was 0.876，0.853，0.789， 0.816， respectively. Conclusion Cardiopulmonary ultrasound can better assess the hemodynamics of sepsis complicated with acute kidney injury and guide clinical management.IVC，EF，PASP，and bilateral lung ultrasound scores have a good evaluation value for the 28-day outcome of ICU sepsis complicated with acute kidney injury.

[Key words] Sepsis; Acute kidney injury; Echocardiography; Intensive care unit

急性肾损伤（acute kidney injury，AKI）是重症监护病房（intensive care unit，ICU）脓毒血症常见并发症，研究结果表明，脓毒症患者AKI的发生率约为50%，AKI合并脓毒症患者的死亡率远高于单纯脓毒症患者[1]。在AKI发生发展过程中，血流动力学紊乱是一个非常重